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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019786
Report Date: 05/11/2021
Date Signed: 05/13/2021 03:36:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SANDOVAL FAMILY CHILD CAREFACILITY NUMBER:
198019786
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 10DATE:
05/11/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Janet Sandoval, LicenseeTIME COMPLETED:
04:30 PM
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This was a Case Management inspection conducted by Susann Sanchez, Licensing Program Analyst (LPA) and due to COVID-19 and precautionary measures this inspection was conducted via Facetime with Licensee Janet Sandoval. This facility is currently under Blanket Wavier 20-04. Per Licensee, hours of operation are Monday to Friday 7:30am to 5:00pm, ages 0 to 13 years old.

During this tele-inspection Licensee Jasmine McDaniel took LPA on a visual tour of the home. LPA note the following during the tour:

The Case Management inspection is for the purpose of inspecting the facility in regards to a capacity increase request. The Licensee is requesting to increase to a Large Family Child Care with a capacity of 12-14 children. LPA observed 9 children and 1 infant with the Licensee and assistant, present at the time of inspection.

All areas identified on the facility sketch were inspected. This is a one story home consisting of two bedrooms and one bathroom, kitchen w/dining area, living room, front yard, and back yard. The backyard has a detached two story apartment. The first floor of the apartment will be used by children and has been granted by Long Beach Fire Department. The Licensee called this space "the studio," which consist of a kitchen and a bathroom. The second story has a different address and is being occupied by a family friend. There is a gate in the bottom of the stairs leading to the second floor to prevent children from going upstairs. The following areas are also used for daycare: Living Room, kitchen w/dining area, bathroom (in the hallway), and backyard. Off limit areas include: Bedrooms and front yards. Also off limits is the outside side walkway that is located on both sides of the house. All off limit areas and inaccessible by barrier or child locks. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Per applicant, there are no dual licenses at this address. LPA observed age appropriate toys and napping equipment for infants.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SANDOVAL FAMILY CHILD CARE
FACILITY NUMBER: 198019786
VISIT DATE: 05/11/2021
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******Page 2******
The value on the 2A10BC fire extinguisher indicates fully charged and is located in the the living room and in the studio as well as a first aid kit. Smoke detectors and carbon monoxide were tested and are operable. This home uses a portable heater and a portable AC. There are toys available for children. Long Beach Unified School District (LBUSD). LPA observed outlet without covers in the living room were children nap. All cleaning supplies were observed to be locked in the bathroom and kitchen. Kitchen knifes are kept in a high cabinet, out of reach of children.
OUTDOOR PLAY AREA: The children will use the back yard for outdoor play, which was observed to be fenced, Licensee also stated that children will be physically and visually supervised at all times. The backyard has a shed in the backyard and the shed was locked off. LPA did inspect shed. Shed is used to store storage.
PETS: LPA observed a bunny and a bird on the premises.
BODIES of WATER: Per Licensee, there are no bodies of water on the premises.
FIREARMS/WEAPONS: Per Licensee, there are no fire arms or weapons on the premises.

LPA reviewed COVID self- assessment and per Licensee temperatures are checked upon arrival. RAST visit was conducted on 08/19/2020.

The following was discussed with the applicant:
· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil Penalties will be assessed if not in compliance.
· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunizations (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license. Licensee CPR and First Aid cards expire on 01/2022.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
· Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SANDOVAL FAMILY CHILD CARE
FACILITY NUMBER: 198019786
VISIT DATE: 05/11/2021
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******PAGE 3******
· Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a family child care home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
· Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.
· Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).
· Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information. Licensee states she does not have liability insurance. Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee submitted proof of immunizations on 03/30/2020. Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com. Licensee's Mandated Reporter training will expire on 12/02/2022.

Infant Care: Licensee doescare for infants. LPA advised the Licensee to sleep infants where they can be directly supervised at all times and advised against sleeping infants in a separate room. The Licensee states the following as a supervision plan for infants: Infants sleep in the living room where she will be providing supervision. LPA observed (2) play pins in the facility. LPA will provided the applicant with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SANDOVAL FAMILY CHILD CARE
FACILITY NUMBER: 198019786
VISIT DATE: 05/11/2021
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*****Page 4*****
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms:
CHILDREN FORMS/RECORDS - Children’s files must contain the following documents/information:
Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Notification of Parent’s Rights (LIC 995A), Caregiver Background Check Process (LIC 995E), Family Child Care Consumer Awareness Information (LIC 9212), Consent/Verification for Nebulizer Care (LIC 9166), California School Immunization Record, Parent Notification for Additional Children in Care (LIC 9150), Affidavit Regarding Liability Insurance (LIC 282), Acknowledgment of Receipt of Licensing Reports (LIC 9224).
FACILITY FORMS/RECORDS - Facility files must contain the following documents/information:
Personnel Records: As required in Title 22 Regulations 102416.1, Unusual incident/Injury Report (LIC 624B): Child Care Facility Roster (LIC 9040), Notice of Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108), Property Owner/Landlord Consent (LIC 9149), Property Owner/Landlord Notification Form (LIC 9149).
INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by Law to post the following:
Facility License (LIC 203), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parent’s Rights (PUB 394). A Notice of Site Visit (LIC 9213): Must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care. All posting were observed to be in the living room on the parent broad.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SANDOVAL FAMILY CHILD CARE
FACILITY NUMBER: 198019786
VISIT DATE: 05/11/2021
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OTHER INFORMATION THAT WAS DISCUSSED:
· Never Shake a Baby, Sudden Infant Death Syndrome (SIDS) and Safe Sleeping practices
· Capacity for a Large Family Child Care
Per applicant, there are no dual licenses at this address.

Corrections: Proof of outlet covers. Due date of correction is May 25, 2021.

A large family child care licensee will be granted upon receipt of proof of corrections for the above and application will be submitted to Licensing Program Manager for final approval. Once licensed, the Licensee is required to comply with the terms and limitations stated on the license. A copy of this report was reviewed and provided to the Licensee via email.

Exit interview was conducted with Janet Sandoval via tele-inspection, during which appeal rights were explained. This report along with a copy of the appeal rights will be sent to the Licensee via email with a read receipt or confirmation of receipt of email, which will act as the Licensee signature.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5